As to the absence of hypophosphatemia in patients with advanced-stage ovarian cancer and high FGF23 in the study mentioned above, one possible explanation is that perhaps other factors are necessary to induce phosphate wasting, such as the overexpression of secreted frizzled related protein-4 and matrix extracellular phosphoglycoprotein (24). This evidence concerns the gene FGF23 and hypophosphatemia.